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The death of Christiaan Barnard has revived some personal memories. More importantly, it reminds us that his operations at the end of 1967 initiated the production of a set of legal and philosophical justifications for the removal of a beating heart from a prospective donor. Thirty four years later they remain a topic of controversy.

Summary points

In 1967, when Christiaan Barnard carried out the first human heart transplants, there were no guidelines for the diagnosis of death of beating heart donors

The relative success of Barnard's second heart transplant was followed by a period of uncontrolled copycat operations in many countries, with predictably poor results

The UK definition of brainstem death, introduced by the Conference of Royal Colleges and their Faculties in 1976, has proved reliable and robust in clinical practice

The operations and my minor involvement

On 3 December 1967 the heart of a young female accident victim was transplanted into a middle aged man suffering from intractable heart failure caused by coronary artery disease. He died 18 days later from extensive bilateral pneumonia. This limited success was hailed throughout the world as a major medical triumph, turned Barnard into an international superstar, and provided the impetus for him to try it again.

His second subject, Dr Philip Blaiberg, was given a heart transplant less than two weeks later, which brings me to the very minor role I played in the whole saga. The “donor,” a young man who had had a severe subarachnoid haemorrhage while bathing in the sea, was admitted under my care. He was, in fact, the last patient I was permitted to admit to Groote Schuur Hospital in Cape Town. A government banning order (under the blanket “Suppression of Communism Act”) included a clause that stopped me from teaching or entering any educational institution. This came into effect next morning.